| NPI | 1265833784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60670972) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA MC60296135) |
| 163W00000X Registered Nurse (Licence: WA RN60469022) | |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2016-08-17 |